The “Story of the Three Bears” has captured the imagination of millions of children since its original version was published in 1837. The tale has evolved over time. In modern versions, the mischief-making invader of the bears’ home has changed from a bad-tempered old woman to Goldilocks, a hungry girl wandering in a forest. Let’s face it, it’s hard to feel sorry for a child who breaks into Mama, Papa and Baby Bear’s house and proceeds to eat their porridge, break a rocking chair, and fall sleep in Baby Bear’s bed. Nonetheless, part of the story’s charm lies in the repetitive rhythm of Goldilocks’ dilemma:
- Too hot..too cold..just right!
- Too fast…too slow…just right!
- Too hard…too soft..just right!
Even if Goldilocks is naughty, even a young child feels how good it is to hit the sweet spot of JUST RIGHT!
When a patient is diagnosed with prostate cancer (PCa), assessing his risk level is essential for treatment planning. This is where the “Goldilocks dilemma” comes in. If risk is incorrectly assessed too high, the patient is likely to be subjected to more tests, and possibly have an aggressive treatment with side effect risks. If it’s incorrectly assessed too low, he may be recommended for Active Surveillance, potentially missing a treatment window if his PCa is quickly progressing to a more dangerous disease.
But, if his risk level is correctly evaluated, it allows for planning next steps (such as more tests if needed) and ultimately choosing a treatment that’s JUST RIGHT.
Risk assessment using Gleason grade vs. MRI
A Dutch research team compared the performance to two different PCa risk calculators, one based on Gleason grade and the other based on MRI/PI-RADS scores.[i] The intent was to use a risk calculator as a decision aid rather than a decision-making tool. The objective was predicting risk of clinically significant PCa, defined as Gleason score ≥3+4. Their study included “data from 1,575 men who underwent biopsy of the prostate between 2018 and 2021 because of suspicion of disease due to abnormal prostate specific antigen (PSA) results. All of the men underwent an MRI exam before biopsy.”[ii]
They found that using the Gleason score-based calculator would have missed almost 20% of clinically significant diagnoses. On the other hand, the MRI-based calculator would miss only 1.2% of clinically significant diagnoses.
At the Sperling Prostate Center, we offer thorough MRI-based risk assessment when there is suspicion of PSA. In many cases, a biopsy proves unnecessary, but if one is needed, our MRI-guided targeted biopsy provides the most accurate PCa diagnosis. Visit our website or contact our Center for more information.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Hagens MJ, Stelwagen PJ, Veerman H, Rynja SP et al. External validation of the Rotterdam prostate cancer risk calculator within a high-risk Dutch clinical cohort. World J Urol. 2022 Oct 16.
[ii] Yee, Kate Madden. “MRI-based prostate cancer risk assessment tool proves effective.” AuntMinnie.com, Oct. 21, 2022. https://www.auntminnie.com/index.aspx?sec=sup&sub=mri&pag=dis&ItemID=138291